Preventing ACL Injuries in the Female Athlete

In my short time in the field of physical therapy, one of the most common injuries in the orthopedic and sports arena are ACL ruptures in female athletes, mainly in the age group of high school to college. Most recently, Olympic alpine skier Lindsey Vonn suffered a reinjury of her already repaired ACL. Hewett, Meyer, and Ford report that females are 4-6 times more likely suffer ACL injuries in landing and cutting sports compared to their male counterparts, and conservative estimates range between $17,000-$25,000 for surgery and rehabilitation per injury.1 We can see not only a financial burden that this kind of injury can have on a patient, but also loss of participation in sport, losing a scholarship opportunity, or even the emotional effects of having a surgery.

The mechanisms of ACL injuries between sexes are roughly the same, but makes women more susceptible? For the sake of this post, the intrinsic factors will be discussed and how to prevent injuries.


  • Shape of the Pelvis: Women have a wider shaped pelvis which changes the dynamics of biomechanical control compared to men.
  • Hamstring Flexibility: Women tend to be more flexible than men, thus leading to a lack of control of the knee during activity.
  • Hormonal: Estrogen and Relaxin concentrations peak during ovulation.
  • Decreased Neuromuscular Control: Anatomical differences, timing of muscle contractions, and laxity of ligaments leave women vulnerable.


Evidence supports plyometrics as an important part of a training program along with combination of strength, agility, and balance.2 With Spring on the horizon and preseason for fall sports right around the corner, seek the expertise of a physical therapist that can help prevent injury during the season and offseason.


  1. Hewett TE, Myer GD, Ford KR. Anterior Cruciate Ligament Injuries in Female Athletes: Part 1, Mechanisms and Risk Factors. Am J Sports Med. 2006. 34(2)299-311
  2. Stevenson JH, Beattie CS, Schwartz JB, Busconi BD. Assessing the Effectiveness of Neuromuscular Training Programs in Reducing the Incidence of Anterior Cruciate Ligament Injuries in Female Athletes: A Systematic Review.  Am J Sports Med. 2014. Published online before print. Accessed. March 9th, 2014.

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